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Original

Choosing and switching biologics for patients with severe asthma: Real-world data from the German Asthma Net (GAN)

Alexandra Lenoir, Roland Buhl, Carlo Muemmler, Jürgen Behr, Rainer Ehmann, Eckard Hamelmann, Anette Holtdirk, Marco Idzko, Margret Jandl, Frank Kaessner, Olaf Schmidt, Christian Schulz, Dirk Skowasch, Hendrik Suhling, Christian Taube, Stephanie Korn, Katrin Milger; and GAN investigators

Volume 10 (2026) p. 158 - 169

Abstract

Allergologie select, Vol. 10/2026 (158-169)

Choosing and switching biologics for patients with severe asthma: Real-world data from the German Asthma Net (GAN)

Alexandra Lenoir¹, Roland Buhl², Carlo Muemmler¹,¹⁶, Jürgen Behr¹, Rainer Ehmann³, Eckard Hamelmann⁴, Anette Holtdirk⁵, Marco Idzko⁶, Margret Jandl⁷, Frank Kaessner⁸, Olaf Schmidt⁹, Christian Schulz¹⁰, Dirk Skowasch¹¹, Hendrik Suhling¹², Christian Taube¹³, Stephanie Korn¹⁴, Katrin Milger¹,¹⁵; and GAN investigators

¹Department of Medicine V, LMU University Hospital, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, ²Mainz University Hospital, Pulmonary Department, Mainz, ³Ambulante Pneumologie mit Allergiezentrum, Stuttgart, ⁴Kinderzentrum Bethel, Evangelisches Klinikum Bethel, University Bielefeld, Bielefeld, ⁵RQMplus Germany, Ahlen, Germany, ⁶Department of Pneumology, University Hospital Vienna AKH, Medical University of Vienna, Vienna, Austria, ⁷Hamburger Institut für Therapieforschung GmbH, Hamburg, ⁸Ambulantes Zentrum für Lungenkrankheiten und Schlafmedizin, Cottbus, ⁹Pneumologie Mittelrhein und Studienzentrum KPPK, Bendorf am Rhein, ¹⁰Clinic and Polyclinic of Internal Medicine, Department of Pneumology, University Hospital Regensburg, University of Regensburg, Regensburg, ¹¹Department of Internal Medicine II - Pneumology, University Hospital Bonn, Bonn, ¹²Pneumologicum Hannover, Hanover, ¹³Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, ¹⁴IKF Pneumologie Mainz and Thoraxklinik Heidelberg, Mainz and Heidelberg, Germany, ¹⁵Division of Respiratory Medicine, Department of Internal Medicine, Lung Research Cluster, Medical University of Graz, Graz, Austria, and ¹⁶Institute of Lung Health and Immunity (LHI), Comprehensive Pneumology Center (CPC), Helmholtz Munich, Member of the German Center of Lung Research (DZL), Munich, Germany
With six biologics available to treat severe asthma in 2025, choosing the optimal initial therapy and deciding to which other biologic to switch in case of insufficient benefit is challenging. To better understand patients’ characteristics depending on the chosen biologic and patterns of switch, we evaluated adult patients with severe asthma from the GAN registry who were biologic-naïve at baseline. Between 2011 and 2024, 2,649 patients with severe asthma newly received a biologic, 26% anti-interleukin-5 receptor (IL5R), 25% anti-IL5, 16% anti-IL4R, 24% anti-immunoglobulin E (IgE), and 9% anti-thymic stromal lymphopoietin (TSLP). Distribution of biologics varied between time periods, reflecting their availability over time. Patients treated with anti-IgE were youngest at asthma diagnosis (mean 26 years) and had the highest rates of allergic comorbidities (80%). Blood eosinophils were highest in patients receiving anti-IL5R (median 433/µL) and lowest in those receiving anti-TSLP (median 159/µL), while FeNO was highest in patients treated with anti-IL5, anti-IL5R, or anti-IL4R (median 39, 38, and 35 ppb, respectively). 14.3% (n = 378) of patients were switched from the first biologic to a different one. The most frequent switch constellations were anti-IL5 to anti-IL5R, anti-IL5R to anti-IL4R, and anti-IL5 to anti-IL4R. After a switch, depending on the constellation up to 46% of patients reached remission. Phenotyping patients with severe asthma determines the choice of biologic therapy in real-world practice. Choice and switch of biologic have evolved over time influenced by availability of different drugs. Our analysis supports the practice of switching to a different biologic in case of insufficient initial response.Correspondence to:
Katrin Milger, MD, Division of Respiratory Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
Email: [email protected]

Original

Dupilumab improves long-term asthma control in German patients with severe asthma: Real-world data

Andreas Renner, Slagjana Stoshikj, Eckard Hamelmann, Dirk Skowasch, Christian Schulz, Margret Jandl, Olaf Schmidt, Katrin Milger, Rainer Ehmann, Christian Taube, Stephanie Korn, Roland Buhl, Marco Idzko, and the German Asthma Net (GAN) study group

Volume 10 (2026) p. 268 - 279

Abstract

Allergologie select, Vol. 10/2026 (268-279)

Dupilumab improves long-term asthma control in German patients with severe asthma: Real-world data

Andreas Renner¹,², Slagjana Stoshikj¹,², Eckard Hamelmann³, Dirk Skowasch⁴, Christian Schulz⁵, Margret Jandl⁶, Olaf Schmidt⁷, Katrin Milger⁸,⁹, Rainer Ehmann¹⁰, Christian Taube¹¹, Stephanie Korn¹², Roland Buhl¹³, Marco Idzko¹,², and the German Asthma Net (GAN) study group

¹Department of Pneumology, Medical University of Vienna, Vienna, Austria, ²Comprehensive Center for Chest Diseases, Medical University of Vienna, Vienna, Austria, ³Kinderzentrum Bethel, Evangelisches Klinikum Bethel, University Bielefeld, Bielefeld, ⁴Department of Internal Medicine II - Pneumology, University Hospital Bonn, Bonn, ⁵Department of Internal Medicine II, University Hospital Regensburg, Regensburg, ⁶Hamburger Institut für Therapieforschung GmbH, Hamburg, ⁷Pneumologische Gemeinschaftspraxis und Studienzentrum KPPK, Koblenz, Germany, ⁸Division of Respiratory Medicine, Lung Research Cluster, Department of Internal Medicine, Medical University of Graz, Graz, Austria, ⁹Department of Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Comprehensive Pneumology Center (CPC-M) German Center for Lung Research (DZL), Munich, ¹⁰Ambulante Pneumologie mit Allergiezentrum, Stuttgart, ¹¹Department of Pulmonary Medicine, University Hospital Essen – Ruhrlandklinik, Essen, ¹²Department of Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik Heidelberg und IKF Pneumologie Mainz, and ¹³Pulmonary Department, Mainz University Hospital, Mainz, Germany
Background: Dupilumab has proven effective in severe asthma, but there is only sparse evidence on its impact on asthma control in a real-world setting. Materials and methods: All patients from the German Asthma Net (GAN) severe asthma registry who initiated dupilumab after inclusion into the registry were analyzed. Clinical effectiveness was evaluated in those with at least 2 follow-up visits, with a maximum followup time of 3 years. Results: A total of 481 patients with severe asthma initiated dupilumab. At baseline, median blood eosinophil count was 174 cells/μL (IQR 61.2 – 436); 184 (38.3%) were former smokers with median 9.6 pack-years (IQR 4.3 – 23.3). Clinical effectiveness was evaluated in 235 patients. The FEV1 increase from baseline was maintained over the whole study period (+300 mL at 4 months and 1 year, +200 mL at 2 and 3 years, all p < 0.0001). The frequency of exacerbations decreased, and the Asthma Control Test score increased from baseline clinically significantly at all timepoints (+4.3 at 4 months, +4.9 points at 1 year, +5.3 points at 2 years, and +4.6 points at 3 years, all p < 0.0001). Dupilumab was well tolerated; < 10% of patients reported adverse events or discontinued dupilumab treatment. The only adverse events recorded in more than 1 patient were conjunctivitis (4 patients), joint pain (3 patients), and flu-like symptoms (2 patients). Conclusion: In this large real-life study of dupilumab in patients with severe asthma dupilumab showed long-term clinical effectiveness for up to 3 years, with results consistent with prior randomized controlled trials.Correspondence to:
Andreas Renner, MD, Department of Pneumology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
Email: [email protected]

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